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Thursday, July 18, 2013

The Epic Knee Disaster of 2013

So I recently realized that I mention often that I am recovering from knee surgery, and on this post I talked about the process leading up to it, but there is SO MUCH MORE to the story! I can't really refer to it as "The Epic Knee Disaster of 2013" if all it was was a simple miniscus tear easily repaired by arthroscopic surgery, can I? So just to give it all a little perspective, let me go back in time for just a moment so that when I talk about my continued recovery and my return to running it all makes a little more sense. If you already know the story - feel free to skip it again. I won't be butt-hurt, I swear! Because, honestly, I don't like thinking about it either.

So last I left you, I had an MRI scheduled with a follow-up appointment with the Ortho the following week. And then on Super Bowl Sunday (of all days), I completely fell apart!!! So let's kind of start there and I'll try to piece this together the best I can without writing a novel in the process.

I had my MRI on that Friday and even though they tell you that it should be a painless process, for me it was most definitely not. It friggin' hurt like hell. I could feel every single pulse of the machine in my knee. I googled it afterwards, and found that for others who had swelling already, they experienced the same thing. I was able to ask a radiology tech about it later and as she described it the magnets in an MRI actually turn your body fluids (blood, etc.) into a single direction so if swelling is present, this could cause pain. Interesting to know after the fact, but man, if I had known ahead of time I would've popped a pain pill ahead of time. At any rate, once it was done, I was thrilled to be done with it! So this was the Friday prior to Super Bowl.

Saturday before Super Bowl was a fairly basic day...lots of pain, but nothing out of what had become the ordinary. I went grocery shopping with the kids helping me so I could walk a little less. Sunday morning I made breakfast and got snacks going for the big game. The family was all coming over and we were also celebrating my hubby's birthday, so I was excited for the day. Super Bowl got under way and I FELL APART. All of a sudden I was so completely overcome with the worst chills I have ever experienced (up to that point). I would have sworn it was -20 degrees in the house, yet it was a nice warm day in the 70's. I couldn't talk I was shivering so bad so I started loading on the blankets trying to get warmer and nothing was helping. That probably went on for a good hour and then the heat came. So off came all the blankets and then I would have sworn the house was in the 90's. This was a fever like I didn't know was possible. Then I tried to get up and walk to the bathroom and experienced such horrible shooting pain in my leg. The swelling had greatly increased during that past hour and no matter how hard I tried to walk it was impossible. I had to be pushed to the bathroom in my office chair and then carried to the seat because putting any weight on my foot was an impossibility. Towards the end of the Super Bowl, we decided that this was probably bad enough to warrant a trip to the emergency room, so off we went with my hubby having to carry me from the door to the truck. I'm not kidding here, I have a pretty high tolerance for pain, and this was some of the WORST I had ever experienced.

So we get to the ER and check in, I'm doing horribly bad and they start off telling us it will be fairly quick that we'll be seen. After waiting for about 2 hours, we checked in and they had gotten several ambulances in and it would be HOURS more. I couldn't do it. I was in so much pain I couldn't even tolerate sitting there in the wheelchair for that amount of time. So we left and went home. I was able to get some off and on sleep by popping pain pills like they were going out of style (all within safety, of course...LOL). The next morning we headed over to an Urgent Care which ended up being the biggest joke ever. The Physicians Assistant that was on duty came in, checked me out and said that the best he could do was maybe an anti-inflammatory injection in my knee. They couldn't prescribe anything for pain at all and said they wanted to send me to, get this, the friggin' Emergency Room (!!!!!), for additional labs. What a joke.

About the time we were sitting there I got a call from the Ortho office telling me they received my MRI results and wanted to see me right away. I already knew, but this was definite confirmation, that there was something seriously wrong with my knee. So off we went to the Ortho doctor to meet with the surgeon, Dr. Panse. So what were the results? Turns out I had a very minor meniscus tear - he described it as a crack and not a real "tear" per se - but the bigger problem was a lot of fluid that didn't belong there which indicated an infection. So arthroscopic surgery would be needed right away and was scheduled for the following Tuesday (so 8 days from that point). In the meantime I had to do all the pre-op labs and x-rays and such, let my work know that I would be out of commission and get everything else in order all while still dealing with what I would describe as the worst flu ever possible. For the next week I suffered all day, every day. I couldn't sleep comfortably. I couldn't eat. I had to use crutches to get around since I couldn't bear weight on my leg at all...even the slightest bump was excruciating. I ran a constant fever which caused chills followed by overheating again and again. It was probably one of the hardest weeks of my life.

I went in for my pre-op appointment at the surgery center and was running a 101 fever and a very high, thready pulse at 114, so there was a moment where I feared the surgery would be postponed which was terrifying because I didn't know how I could make it through any more days like I'd been going through. The surgeon was called and he determined the surgery would go forward as long as my fever came down some.

Finally the surgery day arrived and I was fervently praying, hoping, wishing that the fever was down...it wasn't. But the surgeon decided to move forward anyways. I didn't really realize it at this point, because I wasn't exactly 100%, but the infection in my knee had moved into the rest of my system. The surgeon told me prior to going in that I would no longer be out-patient and would need to be admitted overnight to receive some IV antibiotics. Okay, one night in the hospital...that's do-able. The surgery took place, went well, and I was admitted and sent up to my room following a brief stay in the recovery room. I was definitely sore in my knee, but already I could tell the pain was different now that the infection had been cleared out of the joint. I later asked the doctor how it looked in there and he said it was pretty nasty. They did a little clean-up of debris around the meniscus tear and pulled out 20cc's of pus (AKA the Infection) for biopsy. I still didn't have much of an appetite and my fever was still low-grade every time they took it. Pulse was still a little out of whack too, but we were hopeful that the antibiotics would start kicking in. They started me out on one antibiotic, then had to add another because nothing seemed to be working. The time came for me to be released from the hospital (remember it was supposed to only be a one-night stay) and my fever shot up to 102. The surgeon told the nurses to go ahead and release me with a couple Tylenol, but they decided no way were they going to send me out of there with a 102 temp and called my primary physician. He agreed - she stays. Part of me wanted to just cry because I didn't want to stay there, but I realized that I wasn't getting better and staying was necessary. They began taking blood cultures every time my fever went above 100 and from what I hear from the nurses, they took 5 the first night that protocol was in place. In other words, my fever wasn't going down at all. Meanwhile, all those cultures were down in the lab hoping that something would grow so they could identify what the infection was since it seemed the antibiotics I was receiving weren't working on it. The next afternoon I experienced the same thing that had happened on Super Bowl Sunday where I got the absolute EXTREME chills. The nurse was taking my temp with a temporal scan thermometer and it literally went like this within a few moments: Temp is 100, now 101, it's 102.6, it's 104, it's still climbing. When the nurse said it was 104 my response was "It's broken - that can't be true!". She looked at me like I was delusional, which I'll admit, I probably was.

After getting a good dose of Tylenol and being covered with ice packs the fever began to come down. When the heat began, I was thankful for the ice packs because I seriously felt like my skin could spontaneously combust at any time. All the while, they are drawing more and more blood cultures hoping that something would grow. (Side note: It takes about 3 days for a culture to grow, but sometimes they will begin within 12 hours). So it's now Thursday night, my surgery was on Tuesday morning and they still don't know what is wrong with me. They even called in an infectious disease specialist! At this point I felt like I was on an episode of Mystery Diagnosis!!

Friday morning they FINALLY identified the infection. It was a staph infection (MSSA), but thankfully NOT the resistant kind (MRSA). They began me on a targeted antibiotic and I had close to immediate improvement on that antibiotic. The fever from that point on was low-grade, never going over 101, but hovering in the mid to low 100's and sometimes dropping into the 99's. Friday night I was really hoping to be released, but it didn't come. Saturday morning, hoping again to be released...didn't happen. By Saturday night I was in a foul mood. I was feeling better for the most part, was able to get up and around with a walker, was getting some appetite back and I wanted to be HOME! But they were still concerned about the low-grade fever. Sunday morning I was 100% DONE, DONE, DONE. I was going home. Period. I decided I wasn't going to be a good patient anymore (I only sort of joke on that one). Thankfully the doctor strolled in and said the magic words. I was finally going home. HALLELUJAH!!!

Of course I was going home with a PICC line and two more weeks of IV antibiotics. So, a PICC line for anyone that doesn't know is an IV line that stays in my arm for as long as needed - up to a full year or longer. It comes with a nurse that comes to my house to change the dressing every 5-7 days and to check and make sure it isn't getting infected or anything. I would also be getting in-home wound care for my knee and an in-home physical therapist until I was ready for outpatient. That ended up being two weeks. The stitch (yep, turns out they only needed one very small incision to get in my knee joint and clean it all up!) came out at about the two week mark too. I was hoping to be done with the antibiotics as well since I was told two weeks for that too, but they decided to keep me on those for a full 8-week course to ensure the infection is gone.

Not mine - but exactly what it looked like. I've got to say it was a little funky to have arm "jewelry" and it especially wasn't fun when it would get bumped or pulled while sleeping. Ouch! (Picture Source)

I had my first outpatient physical therapy appointment in early March and my range of motion had definitely increased since the surgery - heck, since the beginning of January really! I was able to walk without the aid of a walker. I felt really good...pretty much normal for the most part. I was exhausted still the first couple of weeks and at the beginning it was hard to even walk to the bathroom. Going up the stairs took everything I had. My recovery was not without challenges, but it was such an improvement from where I was!

The doctor took me off of work for 8 weeks, but I was able to get early clearance to return, so it ended up being about 5 1/2 weeks that I was off of work. Going back felt great, but it was exhausting and it was very hit and miss for several more weeks because I still had physical therapy twice a week on Tuesdays and Thursdays and the visit with my PICC line nurse every Wednesday.

All in all, I feel like I completely lost the first half of 2013. The end of January and all of February were pretty much spent in a fog. I never realized how much I was losing at the time, but looking back I can see that the infection was taking so much out of me, even though I didn't know what it was at the time. I was thinking it was just a meniscus tear, but it was so much more. I just remember waking up every morning and feeling worse then the day before and I couldn't understand that because I was doing EVERYTHING to make it better - resting, icing, elevating, taking anti-inflammatories, etc. In a normal world I would have been getting BETTER every day. But this was not "normal".

They can't say for sure what caused the infection (which, by the way, is a rare type of infection because it was in a closed joint), but there are two lines of thought. 1) when I received an injection in my knee joint because my "fluid was low" back towards the beginning of December at the doctor's office; it may have been on my skin and when it pierced the skin it went right on in; or 2) that I've had a UTI (even though I have absolutely NO symptoms) that entered my blood stream and then attacked the weakest part, in this case, the knee where the meniscus crack already was.

All I know at this point is that the road to recovery is not an easy one! It's been difficult to accept that my body isn't what it used to be and getting over the fear and constant worrying every time my knee pops or I feel a slight chill has been difficult. I am always super careful with my knee and right now my biggest concern with that is making sure I'm not over-protecting it and cause a different injury instead. Especially now that I'm back to running on a regular basis - the last thing I want to do is baby that knee and cause ITB or a pulled muscle because I altered my gait or something. I have to say that I had no idea how awesome Physical Therapists were, but those that do their job right have all my respect and admiration that I have to give! I really feel like my therapist gave me my life back! I was released from therapy at the end of April and in the 8 weeks that I spent with them they made progress with my injury every. single. time. I just absolutely adore the folks at Physical Therapy Sports Institute and cannot thank them enough!

Earlier this month I got the final clearance from my surgeon after taking follow-up x-rays and blood work so the infection hasn't been lying low hiding out just waiting to strike again. And that's one of the hardest things to accept about this whole thing - that in the end, it wasn't even something that I had any control over. It wasn't an "injury" even though I keep calling it that because calling it anything else confuses people. When I say "infection" they usually think I got the infection from the surgery. Nope - it was there already. The whole ordeal from start to finish (and really, it still isn't finished technically speaking) was one of the hardest things I've ever gone through. But it was a great reminder that if you think something is wrong - keep pushing your medical professionals to keep digging!!! You are the only true advocate for your health care.